Repeal and Replace

has become the most important jargon, to date, in the 2012 race for the presidency


Eric LaMont Gregory

 
The term jargon is used to describe speech or writing that is often pretentious in nature, employs convoluted phrasing, and is in many instances rather vague.  And, within that definition 'repeal and replace' has taken center stage.

I will leave it to others to discuss the political jargon that surrounds the mechanisms of repealing The Patient Protection and Affordable Care Act, disdainfully known as Obamacare.  Repeal of that legislation lies within executive perogative and the machinations of congressional procedures that if employed would 'reconcile' the current president's health plan out of existence. 

Romney states, if elected president this November, that he will give [offer] a waiver to all 50 states allowing them to "discontinue" the Patient Protection and Affordable Care Act.  Notwithstanding the fact that Obama used the waiver to allow states not to
implement most of the Bush 'No Child Left Behind' educational reforms.

In addition, there is the fact that some of the provisions of the Act are very popular among many voters, such as those letting young Americans remain on their parent’s insurance policy until 26 years of age, closing the Medicare gap in prescription drug coverage, and the remedy for coverage of those with pre-existing conditions. 

There is real disagreement among Republicans between conservatives who do not want to promise to keep even the most popular planks of Obamacare, and the more moderate forces who want to embrace independent voters who support them.   

Romney states that his replacement plan will return healthcare responsibilities to the states where he believes they rightfully belong.  And, since it is obvious that the states need money to finance such a plan, Romney wants to take Medicaid money currently administered by federal agencies and give it to the states as block grants, which would in effect dismantle the federal Medicaid system as it exists now.

The states currently need some 150 billion dollars to beef up their high risk health coverage pools, and there is nothing preventing the present congress or the executive from providing those funds today.  Where is a treasury secretary with the wisdom of an Alexander Hamilton, when you need one - some of the debts of the states should become the burden of the nation as a whole.  

The only thing preventing such a move is politics itself.  This administration does not want the embrassment of trying to give money to the states, some of whom would refuse it as a matter of principle hoping to be able to accept it after the election when the press will be on to other matters.

Though not mentioned in Romney's plan, one assumes that he is aware that forgiving the states the money they owe the federal government in Medicaid matching funds would go a long way towards reducing large structural budget deficits in the several states including New York, Ohio and especially California.  Again, though not mentioned it is assumed that Romney would distribute health care funds to the states in terms of their population, and not against some less fair concept like poverty. 

Romney's plan also includes giving individuals the same tax advantages that companies have when they buy health insurance for
their employees.  He also wants to allow individuals to buy insurancee across state lines which is not the way the unsurance industry is currently regulated.  All in all, Romney believes that by encouraging consumers to shop around for medical services, a more competitive health care provider market will be created.

Although, to do all these things is a task that would make the passage of Obamacare seem like a walk in the park, nonetheless Romney's health care plan incorporates features that the current plan which he wants to replace does not.  And, as a matter of policy, does not take the American health care system further down the path towards a single payer system as a prelude to universal coverage.

The system of - if you are employed - you are insured - is a New Deal era reform which reflects a time when it was reasonable to assume that a person could work for the same employer for one's entire career.  In effect, the insurance policy and the tax breaks, were owned by the employer and given to the employer, respectively.

Life expectancy tables at that time recorded European males paying into the Social Security and Medicare system and retiring at age 65, while their African American counterparts paid into the system but died before the age of sixty-five and so never drew money from the system.  Life expectancy has improved and demands on the social security system have increased accordingly.

Allowing individuals to own their own insurance policies and being able to buy insurance with pretax income, is a reform that is long overdue.  Forcing the states to allow individuals to buy insurance across state lines is more problematic.  If one believes in state sovereignty, then one does not dismantle a system which to date is clearly within the purview of the states.  Romney will need to have Republican control of both houses of the congress and the support of the states to effect such changes.  Whether the states are willing to go along with such a fundamental change in insurance regulation is anybody's guess.  

Dismantling the federal Medicaid system and turning it over to the states is not without its problems, and representing a party that espouses the belief that private sector techniques would improve management of our public sector would however, finally be put to its ultimate test.

Some have suggested that Romney ought to draw a line and distinguish the parts of the health care system adopted in Massachusettes during his administration, from the changes in that system that took place after his tenure.  That carries with it a number of problems, not the least of which is the fact that once a seed in planted one expects a plant to grow.  There is little to be gained by a point by point analysis of the changes that have taken place in the Massachusettes health care plan that was the model for the president's recently upheld health care reforms.

Update:

No less than 30 times over the last 18 months House Republicans have voted to repeal or defund the Patient Protection and Affordable Care Act.  This week, July 9 2012, the House will take up attempt number 31.  Members of the House know that even if Mitt Romney wins the November election, that it will be difficult for the Republicans to actually repeal Obama's signature health legislation.            
                             

President Dwight D Eisenhower

  'We must avoid extremes ... of waste and inflation which could reduce job opportunities, price us out of world markets and
shrink the value of savings.  To keep our economy sound and expanding, I shall ... present to the Congress a balanced budget.'

http://www.theoxfordscientist.com/can-romney-win.html